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Disorder according to the APA
- A behavioral or psychological syndrome or pattern that occurs in an individual
- Reflects an underlying psychobiological dysfunction (new to DSM-5)
- Consequences are clinically significant distress or disability
- Must not be expectable response to common stressors or losses or a cultural standard
- Not primarily result of social deviance or conflicts with society
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What is the most important factor in childhood psychological disorders?
Age is the most important
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Indicators of disorders
- Time course
- Quantitative indicators (high/low freq; high/low intensity)
- Qualitative indicators (inappropriate to situation; beh qualitatively different from normal)
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Age of onset Birth to 6 years of age
- Language Disorders
- Austism Spectrum Disorder
- Rett's Disorder
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Age of onset 6 to 12 years of age
- ADHD
- CD
- Specific Learning Disorders
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Age of onset 12 to 18 years of age
- SZ
- Drug Abuse
- Bulimia Nervosa
- Anorexia Nervosa
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Higher prevalence for boys
- IDD
- Language
- Learning
- ASD
- CD
- Rumination
- Encopresis
- Enuresis
- Tourette's
- Substance Abuse
- ADHD
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Higher prevalence for girls
- Rett's
- Anxiety
- Depression (later in life, early its equal)
- Eating
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Equifinality
Different pathways, same disorder
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Multifinality
Similar pathways, different disorders
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Multideterminism
Disorders have many causes
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Psychoanalytic Theory
- Id (Child)
- Ego (Arbiter)
- Superego (Rule-maker)
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Midbrain
Motor supply to muscles
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Pons
Face sensation & movement
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Medulla
- Breathing
- Heartbeat
- Digestion
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Cerebellum
Controls motor coordination
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Thalamus
Relay station for sensory input
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Hypothalamus
Regulates behavior & emotion
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Limbic System
- Regulates: Emotional experiences, expressions, basic drives
- Critical for learning and impulse control
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Basal Ganglia
- Regulates, organizes, filters info related to cognition, emotions, mood, & motor function
- Highly connected to frontal lobes
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GABA
- Inhibitory NT
- Moderates emotional response, anger, hostility, aggression
- Linked to anxiety and discomfort
- Implicated in Anxiety Disorders
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Dopamine
Involved in exploratory, extroverted and pleasure-seeking behavior
Implicated: SZ, Mood, ADHD, Substance Abuse
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Norepinephrine
- Controls emergency reactions & alarm responses
- Role in regulating emotions & behavior
- Acts to modulate behavioral tendencies (OCD, etc.)
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Serotonin
- Information processing
- Motor coordination
- Inhibits tendency to explore
- Regulates eating, sleeping, aggression
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Experiments
Test cause and effect
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Within-Subjects
Different conditions applied to each subject
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Between-subjects
Different conditions applied to different subjects
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Ranking of rates
Lifetime prevalence > Prevalence rates > Incidence rates
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Incidence Rates
Number of new cases of a disorder in a specific period
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Prevalence Rates
All cases observed at a specific point in time
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Lifetime Prevalence
Number or proportion of cases of a disorder diagnosed at any time in life
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Confirmation Bias
Viewing possible normal behaviors as from a disorder due to a label
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ADHD - Inattentive Presentation (Restricted)
- 6 + Inattentive
- No more than 2 Hyper-Impulsive
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ADHD - Predominantly Inattentive Presentation
- 6 + Inattentive
- 3-5 Hyper-Impulsive
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ADHD - Predominantly Hyper-Impulsive
6 of 9 Hyper-Impulsive
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ADHD - Combined Presentation
6 + of both
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ADHD - Criteria
- Symptoms present before 12
- Present for 6 months
- Must occur in 2 settings
- Maladaptive
- Symptoms not from another disorder
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ADHD - Causes
- Genetics (highly heritable)
- Neurobiology (Frontal lobe; NTs dopamine and norepinephrine)
- Birth complications (LBW; injury at birth; small body size; prenatal smoking and alcohol)
- Psychosocial
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Destructive-Covert
- Property Violations
- -Setting fires
- -Stealing
- -Vandalism
- -Lying
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Destructive-Overt
- Aggression
- -Assault
- -Blaming
- -Fighting
- -Bullying
- -Cruelty
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Nondestructive-Covert
- Status Violations
- -Abusing substances
- -Running Away
- -Swearing
- -Breaking rules
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Nondestructive-Overt
- Oppositional Behavior
- -Annoying
- -Defiant
- -Arguing
- -Stubbornness
- -Anger
- -Touchiness
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ODD
- Lasting 6 months
- 4 symptoms with at least one non-sibling
- -Angry/Irritable Mood
- -Argumentative/Defiant
- -Vindictiveness
- (No physical violence)
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CD
- 3 symptoms in past 12 months, 1 at least in past 6 months
- -Aggressive to people and animals
- -Destruction of property
- -Deceitfulness or theft
- -Serious violation of rules
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CD-additional specifier
- Significant Callous-Unemotional Traits
- -2 or more in past 12 months in at least 2 different settings/relationships
- -Lack of remorse or guilt
- -Callous-lack of empathy
- -Unconcerned about performance
- -Shallow or deficient affect
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ASPD
- Impairments in Self-functioning
- -Ego-centrism or Self-direction goal-setting
- Impairments in interpersonal functioning
- -Lack of empathy or intimacy
- Antagonism
- -Manipulativeness, decietfulness, callousness, hostility
- Disinhibition
- -Impulsivity, risk-taking
- Stable across time
- Not normative, nor substance related
- At least 18
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Substance Use Disorder
2 or more symptoms within a 12-month period
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Splinter Ability
One that is relatively normal
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Savant Ability
Especially high ability compared to norms
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ASD
- Persistent deficits in social communication, interaction
- -Social-emotional reciprocity
- -Nonverbal communication
- -Developing and maintaining relationships
- Restricted, repetitive patterns/interests (2 of them)
- -Speech, motor movements, use of objects
- -Excessive routines/patterns resistant to change
- -Fixated interests
- -Hypo/Hyper-reactivity to sensory input
- Present in childhood
- Limit everyday functioning
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IDD - Deficit Areas of Adaptive Functioning
Conceptual, Social, Practical
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Fragile-X
- Pinched X chromosome
- Large forehead, prominent jaw, low protruding ears, macroorchidism
- Hypervigilant/sensitive
- Quantitative/Visuospatial deficits
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Williams
- Deletion of material from chromosome 7
- Elfin appearance
- Local over global
- Dampened amygdala activity
- Cocktail party syndrome, poetic language, musical prowess
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Prader-Willi
- 7 genes on chromosome 15 missing
- Short stature, low muscle tone, urge to eat
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Angelman
- 7 genes on chromosome 15 missing
- Large jaw, open mouthed expression, stiff walk
- Profound desire for interaction, happy disposition
- Fascinated with water
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Lesch Nyhan
- Deficiency in HPRT
- Self-mutilating
- Hypotonia, chorea
- Some evidence of a lessened sensitivity to pain
- Sandy diapers
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FAS
- Smooth Brain, microcephaly
- Smooth filtrum, thin vermillion, short palpebral fissures
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Semantics
The meaning of words
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Pragmatics
The use of language in context
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Speech Sound Disorder
- Problems with phonology (making the correct sounds)
- Sound omissions are worse than sound substitutions
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Language Disorder
- Problems with morphology, semantics, or syntax
- (e.g. use of color-ers instead of crayons)
- Also related to problems with reading
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Social (Pragmatic) Communication Disorder
- Problems with pragmatics (cannot use language in social contexts)
- Must rule out ASD
- New DSM-5 diagnosis
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COS SZ
- Onset younger than 13
- Two or more symptoms (at least one must be delusions, hallucinations, or disorganized speech) present for 6 months
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Major Depressive Episode
- 5+ in same 2-week period
- Depressed most of day (kids could be irritable)
- Anhedonia
- Weight loss
- Sleep issues
- Psychomotor agitation/retardation
- Fatigue
- Worthlessness
- Diminished think or concentrate
- Thoughts of death
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Major Depressive Disorder
- Single (1 MDE) or Recurrent (2+ MDE)- Presence of MDE, no manic or hypomanic
- To be considered separate must be interval of 2 consecutive months
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Dysthymic Disorder
- Depressed mood most of day for at least 1 year (adults - 2 years)
- 2+ of
- poor appetite/overeating
- Sleep problems
- Low energy or fatigue
- Low self-esteem
- Poor concentration/decision making
- Hopelessness
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Depressive Disorders - Neurobiological Influences
- Decreased frontal lobe volume
- Increase limbic system activity
- Reduced hippocampus volume
- Disturbances in HPA
- Low Serotonin, Dopamine, Norepinephrine
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Bipolar Type I
Mania (psychosis or clinically significant distress) for at least 1 week
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Bipolar Type II
Hypomania (at least 4 days) + MDE
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Cylcothymia
Hypomanic symptoms, depressive symptoms (no MDE, no hypomanic episode; 1 year)
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MDD w/ Mixed Features
MDE + 3 non-overlapping hypomania or mania for 2 weeks
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Bipolar Type I w/ Mixed Features
Mania + 3 non-overlapping features of depression (1 week)
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Bipolar Type II w/ Mixed Features
Hypomania + 3 non-overlapping features of depression (4 days)
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Disruptive Mood Dysregulation Disorder
- 3 or more temper outbursts per week w/ verbal or physical aggression out of proportion
- Persistently irritable
- Present for 12 or more months (without 3 or more consecutive months of no symptoms)
- Two settings
- Not before age 6 or after 18
- Onset of symptoms before 10
- Not during MDD, not with ODD or BD --> if ODD features only DMDD diagnosed
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Bulimia Nervosa
- Rigid, "all or nothing," black and white attitude
- Overeating and purging
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Anorexia Nervosa - Restricted
Highly controlled, rigid with obsessive tendencies (no b & P)
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Anorexia Nervosa - B & P
Impulsive behaviors, self-injury and substance misuse, more negative outcomes (last 3 months)
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Binge Eating Disorder
- At least once a week for 3 months
- No compensatory behavior
- Marked distress from binge eating
- Associated with low Ghrelin
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Body weight issue
Significantly underweight is a criterion for AN, NOT BN or BED
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Bingeing
All could be except AN - Restricted
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Compensatory Behavior
No CB in BED. Only present in BN & AN - B & P
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